Respondent Name has participated in the 50+ in Europe study before [his/her] death. [His/Her] contribution was very valuable. We would find it extremely helpful to have some information about the final year of Respondent Name's life. All the information collected is strictly confidential, and will be held anonymously.

We would now like to ask you some questions about any expenses which Respondent Name incurred as a result of the medical care [he/she] received in the last 12 months before [he/she] died. For each of the types of care I will now read out, please indicate whether the deceased received the care and, if so, give your best estimate of the costs incurred from that care. Please include only costs not paid or reimbursed by the health insurance or the employer.

Has Respondent Name had any [care from a general practitioner/care from specialist physicians/hospital stays/care in a nursing home/hospice stays/medication/aids and appliances/home care or home help due to disability] (in the last 12 months of [his/her] life)?

About how much did [his/her] [care from a general practitioner/care from specialist physicians/hospital stays/care in a nursing home/hospice stays/medication/aids and appliances/home care or home help due to disability] cost (in the last 12 months of [his/her] life)?

We would like to know more about the difficulties people have in their last year of life because of a physical, mental, emotional or memory problems. During the last year of [his/her] life, did Respondent Name have any difficulty remembering where [he/she] was? Please name only difficulties that lasted at least three months.

Because of a physical, mental, emotional or memory problem, did Respondent Name have difficulty doing any of the following activities during the last twelve months of [his/her] life? Please name only difficulties that lasted at least three months.

The next questions are about the assets and life insurance policies the those assets after Respondent Name died. I appreciate that this may to have some information about the financial issues surrounding death. that everything you have already told me and anything else you tell me

I will now read out a few types of assets people may have. For each item, please tell me whether the deceased owned them at the time of [his/her] death and, if so, please give your best estimate of their value after any outstanding debts.

About what was the value of the [businesses, including land or premises/other real estate/cars/financial assets, e.g. cash, bonds or stocks/jewelry or antiquities] owned by Respondent Name at the time of [his/her] death?

We have asked you many questions about numerous aspects of Respondent Name 's health and finances, and we want to thank you very much for your assistance with them. Is there anything else you would like to add about the life circumstances of Respondent Name in [his/her] last year of life?